On the occasion of the past January 13, 2023 which was commemorated the world day of the fight against depression I want to comment in this post about this mental disorder that annually claims millions of lives and that spares no person regardless of their condition. It is necessary to clarify certain terms and concepts that in the general vocabulary of people are often confused, even studying psychology you have to know how to differentiate very this type of constructs to avoid committing any malpractice. Therefore in this post we will talk about depression and sadness, which is the most common thing that is usually associated with this pathology, I will also comment on the disorder and types.
When we refer to depression, it is commonly associated by ignorance to a deep sadness or to a person who manifests to be sad most of the time, but nothing further from reality, although to talk about sadness we must understand what emotions are and how they are involved in what we know as depressive disorders.
Emotions are alterations of the affectivity and feelings of individuals, which serve as a response to external stimuli, social communication with the environment that can be manifested through the behaviors and actions of people. Emotions have their origin in philosophy where they defined morally accepted behaviors and those that are not morally accepted, but until the advances of scientific knowledge it was proven that these have their physiological origin in anatomical structures interconnected in neural networks in different parts of our brain structure.
Emotions have several functions but the main ones are adaptive and evolutionary for the development and survival of human beings, they help us to communicate with each other as a society and as individuals when interpreting our own actions. Emotions are not standardized since they depend on the subjectivity of each individual to manifest themselves, there are only generalized behaviors and actions to identify them in the person, however these will always be subject to the judgment of the person who experiences them and according to the behavioral, cultural and individual models in which the individual is. Another factor that influences the way emotions respond is temperament, since it is associated with a great genetic load that influences the expression of emotions.
Now, as we refer to sadness, it is a primary emotion that is evoked by events of separation, bonds, grief, physical and psychological losses, by catastrophic events that lead us to manifest a feeling of rejection or displeasure before x situation or event, it has an adaptive function to respond to negative events and a social function to receive support and help. The location in space and time of sadness can be focused on the past, present and future. People who experience sadness can be interpreted in generalized behaviors such as withdrawal or isolation of the person from their social environment, keeping a low profile, physiological expressions such as crying and sometimes even aggressive behaviors.
Sadness is a uni¬versal feeling, consubstantial with the existence of man, it is part of the affective functions or also known as mood functions and its presentation obeys a response to the adversities of the subject's life. Sadness without cause, without reason is the one that has no relation with the triggering factors, and in case there are any, they have no proportionality with the intensity, duration and functionality of the individual (Patricio, 2017, p. 175).
The state of sadness that lies between the limits of the healthy and the pathological is melancholy, which consists of a state and feeling of progressive and lasting anguish, which can vary according to the context of the circumstances of the person at the level of physical, psychological, social and individual health. There are many events in everyday life that can trigger a state or feeling of melancholy that can last for a long time, such as the physical loss of a close person, the separation of an affective bond with someone or a chaotic social situation that maintains the melancholic mood.
The term depression refers to a mental illness involving the following clinical aspects that are altered during the course of the illness: affectivity, thinking-cognition, behavior, biological rhythms and somatic disorders.
In the affective area there are characteristics such as apathy, anxiety, anhedonia; in thinking-cognition we can observe melancholy, hopelessness, suicidal ideas, attention and concentration deficit; in the behavioral area we observe personal abandonment, suicide attempts, isolation and crying; when referring to biological rhythms we speak of seasonal changes of the year such as spring and autumn, which directly affect mood causing symptoms characteristic of depression and in somatic disorders we find comorbidity with anorexia, insomnia and hypersomnia, digestive disorders, asthenia and sexual dysfunctions.
Depression is a clinical diagnosis that should not be associated only to the state or feeling of sadness since, apart from being a disease with several clinical aspects, it requires a deep psychodiagnostic evaluation of the symptoms, the appearance, the duration of the symptoms and the reaction to the treatment provided and to the individual psychotherapy.
This pathological alteration of mood is actually a heterogeneous group of diseases or affective disorders, with a very broad spectrum that includes classic pictures such as "major depression" to atypical pictures, secondary or variants of a form of normal psychic reaction; but, which share as characteristic of this pathological mood, the extreme dysfunctionality or limitation of its capabilities, the chronicity of the same and the accompaniment of other symptoms of depression (Patricio, 2017, p. 175).
Endogenous depression is divided into two types, "Unipolar" which are those endogenous depressive disorders that have presented several consecutive melancholic phases without an intercurrent manic or hypomanic episode and "Bipolar" which are those that alternate melancholic periods with other manic or hypomanic ones. Given the clinical, social and cultural complexity of this disorder, there are several risk factors that can influence a person to suffer from the disease.
Biological: 1. Genetic. Family history not only differentiates types of unipolar depressions (pure depressive disorder-depressive spectrum-non-familial affective disorder), but also predicts endogenity in apparently neurotic depressions. Biological markers. Still under study. Persistence of urinary MHPG and 5-HIAA in CSF, decreased after clinical recovery, indicate risk of relapses. Shortened REM latency, together with other data (hypersomnia), characterizes a group of apparently characteristic but biologically based depressions. Of particular interest are studies that have shown that depressive patients, even recovered, have a low threshold of REM sleep discharge to arecoline, which is interpreted as a genetic vulnerability linked to the cholinergic system and to neurobiological mechanisms in general. 3. Premenstrual syndrome. Accumulation among women with affective disorders of antecedents with premenstrual depressive symptoms. Morphobiological abnormalities in general and specifically brain abnormalities predict poor response to psychotherapy and advise biological treatments (Vallejo, 2015, pp. 631-632).
B. Sociodemographic variables: 1. Sex. Predominance in women of non-bipolar affective disorders. Although the cause is debated, it is possibly due to psychological and social factors. Completed suicide is more frequent in males. Although the postpartum and premenstrual periods are times of higher risk, menopause does not seem to increase the risk of depression. 2. Age. Bipolar disorders begin earlier than non-bipolar disorders. 3. Marital status. Although Kaplan's work suggests a high risk for married women, since the differences disappeared when comparing the sexes in other states (single, widowed), this is a matter of debate and in any case the difference only remains in non-bipolar disorders. Separation and divorce are linked to depressive symptomatology. 4. Other variables. The data on education and socioeconomic level are contradictory. There is an inverse relationship between social class and non-bipolar disorders, while bipolar disorders are more prevalent in the upper classes. Depression occurs in all cultures, although in primitive cultures it acquires a peculiar symptomatic expression (more somatizations, hypochondriasis and paranoid experiences, and less feeling of guilt). Religion does not seem to be a specific risk factor, but among Catholics and Jews the suicide rate is lower. The work-depression relationship is curvilinear, so that the highest incidence occurs at the highest and lowest positions on the scale (Vallejo, 2015, p. 632).
C. Psychosocial aspects: 1. Personality and cognitive style Depressive personality. Parental losses. The classic theories of Freud and Abraham on infantile parental losses took consistency with the studies of Brown and Harris (1978) in Camberwell, where these facts in women, together with a scarce interpersonal relationship, unemployment and the presence in the home of three or more children under 14 years of age, constitute vulnerability factors that in the presence of triggers lead to depression. However, the issue is controversial, since not all studies confirm these data. 3. Social support. Poor interpersonal relationships, especially with one's partner, constitute a factor of vulnerability and poor prognosis for depression. 4. Life events. Several authors have noted the high frequency of significant events, occurring months before the onset of a depressive episode, and have underlined the negative nature (losses) of these events, while emphasizing the interaction established with other factors (heredity, personality, family context, interpersonal relationship, lifestyle, parental losses, etc.), which favors a multifactorial model. Life events are numerous in both bipolar and unipolar disorders, and as frequent in endogenous as in neurotic depression. However, in the former (endogenous) they are more relevant in the first episode than in the following ones. Other factors have also been described, rooted in childhood: childhood sexual abuse, physical abuse, poor perception of their role in the family and educational style, as well as high overprotection and/or low parental affection in neurotic depressions (Vallejo, 2015, pp. 632-633).
Depressive disorders belong to a family of affective disorders that consist of a cyclical alteration of moods that go from euphoria to depression. As it is well explained, they are alterations in the affective and mood sphere of people, consequently other areas that depend on this sphere such as motivation, feelings, socialization, behaviors and self-perception are altered.
They are disorders in which the fundamental disturbance consists of an alteration of mood or affectivity, which tends to depression (with or without concomitant anxiety), or to euphoria. This change in mood is usually accompanied by changes in the general level of activity, and most of the other symptoms are secondary to these changes in mood and activity, or easily explained in the context of them. Most of these disorders tend to be recurrent, and often the onset of each episode is related to stressful events or situations (ICD-10, 2008, p. 315).
In the classification manuals of mental disorders such as ICD-10, depressive disorders are part of the same family of mood disorders, therefore they are in the same categories along with other affective disorders such as Manic Episode, Bipolar Affective Disorder, Recurrent Depressive Disorder and Persistent Mood Disorders.
In the DSM-V classification is different, here depressive disorders are a separate family with its own section in this manual that are distinguished from other disorders. These are mentioned below:
- Trastorno de desregulación disruptiva del estado de ánimo
- Trastorno de depresión mayor
- Trastorno depresivo persistente (distimia)
- Trastorno disfórico premenstrual
- Trastorno depresivo inducido por una sustancia/medicamento
- Trastorno depresivo debido a otra afección médica
- Disruptive mood dysregulation disorder
- Major depressive disorder
- Persistent depressive disorder (dysthymia)
- Premenstrual dysphoric disorder
- Substance/medication-induced depressive disorder
- Depressive disorder due to another medical condition
The fact that depression is a silent disorder alludes to the complexity of diagnosing and treating it early, before complications or suicidal behaviors occur. The obstacle is not how difficult it is to diagnose it, but many factors that make the evaluation more complex, such as the professional preparation of the psychiatrist or psychologist with an acute evaluation free of prejudices, objective and allowing flexibility in the cases, since there have been many occasions where a person is diagnosed with depression when in fact he/she does not suffer from it.
Another aspect that influences is the level of awareness of illness that the person has at the time the symptoms appear, many people prefer to think that something else is wrong or it is just a bad moment in the stage of their life than to assume that they are going through a depressive episode that can worsen if not attended and for the person to reach that level of awareness has to do much individual, family, social and cultural factors that may facilitate or obstruct this self-questioning, so it is necessary a culture that is implemented mental health as a priority.
Unfortunately, depression is silent but it makes noise when we hear the sad news of its victims through suicide. The prevalence rate of depression in the United States is at least 7% (and this percentage may increase depending on the level of development of the country), being three times higher in people between 18 and 29 years of age, being the population with the highest risk of suffering from it before the population over 60 years of age.
Well my dear readers, I hope you have enjoyed this delicate and important topic and that it has served as beneficial knowledge for you and for others, since mental health is something that all human beings share and are always exposed to. If you have any comments or opinions I will be delighted to read them in the comments.
Well my dear readers, I hope you have enjoyed this delicate and important topic and that it has served as beneficial knowledge for you and for others, since mental health is something that all human beings share and are always exposed to. If you have any comments or opinions I will be delighted to read them in the comments.
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Martínez, A. C., & Bouquet, R. I. (2007). Tristeza, depresión y estrategias de autorregulación en niños. Tesis Psicológica, (2), 35-47.
Levav, M. (2005). Neuropsicología de la emoción. Particularidades en la infancia. Revista Argentina de Neuropsicología, 5, 15-24.
Sutil, C. R. (2013). ¿ Qué es una emoción? Teoría relacional de las emociones. Clínica e Investigación relacional, 7, 2.
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Benavides, P. (2017). La depresión, evolución del concepto desde la melancolía hasta la depresión como enfermedad física. revistapuce.
Pérez-Padilla, E. A., Cervantes-Ramírez, V. M., Hijuelos-García, N. A., Pineda-Cortés, J. C., & Salgado-Burgos, H. (2017). Prevalencia, causas y tratamiento de la depresión Mayor. Revista biomédica, 28(2), 73-98.
Agudelo, D., Buela-Casal, G., & Spielberger, C. D. (2007). Ansiedad y depresión: el problema de la diferenciación a través de los síntomas. Salud mental, 30(2), 33-41.
Agudelo Martínez, A., Ante Chaves, C., & Torres de Galvis, Y. (2017). Factores personales y sociales asociados al trastorno de depresión mayor, Medellín (Colombia), 2012. CES Psicología, 10(1), 21-34.
Vallejo Ruiloba, J. (Director). (2015). Introducción a la psicopatología y a la psiquiatría (8.a ed.). A. Parras.
Organización Mundial de la Salud. (2008). Clasificación estadística internacional de enfermedades y problemas relacionados con la salud (10ª ed.). http://www.who.int/classifications/
Asociación Americana de Psiquiatría, Manual diagnóstico y estadístico de los tras-tornos mentales (DSM-5®), 5a Ed. Arlington, VA, Asociación Americana de Psiquiatría, 2014
Por desgracia es el trastorno más común y uno de los más difíciles de sobrellevar, pues, gran parte del tratamiento requiere de la disposición del paciente y es muy entendible que en muchos casos no se encuentre en condiciones de querer hacer algo por si mismo. Por eso desde pequeños es importante fomentar el amor propio, la empatía y la confianza. Gracias por hablar de ello😍
Gracias por tu comentario ✨ así es la salud mental de nuestros infantes es de vital importancia cuidarla y que se desarrolle de manera sana para evitar estás consecuencias en la adultez
Muy instructivo este post. Te felicito por tu trabajo
Muchísimas gracias saludos!!✨💪
Un post súper completo y con información muy necesaria para entender este trastorno 👏🏻
Me alegra que te haya gustado 💜
Podríamos decir que la depresión es uno de los principales problemas que la sociedad está enfrentando en la actualidad,muy limitante, y pienso que no se les está prestando la suficiente atención. Creo que hace falta educación en las personas en general para que aprendan a reconocer este problema, y sobre todo, brindar herramientas para que sepan como superarlo, o en tal caso, poder ayudar a quienes lo ameriten, sin embargo, lo ideal es que las personas acudan a especialistas.
Totalmente de acuerdo es necesario que las personas sean conscientes de estos problemas y que estén dispuestos asistir a especialistas en el tema y que esté en la cultura de las persona priorizar su salud mental como lo hacemos con una dolencia física(evidentemente brindando la atención y los recursos necesarios para los diferentes esctratos sociales). Gracias por su comentario ✨👏🏻
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